Saudi Journal of Gastroenterology
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Year : 2004  |  Volume : 10  |  Issue : 3  |  Page : 140-143
Salmonella carriers among expatriate workers in Al-Qatif area

1 Dr. Hassan Al-Breiki polyclinic, Qatif, Saudi Arabia
2 College of Medicine, King Faisal University, Dammam, Saudi Arabia

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Date of Submission22-Jun-2003
Date of Acceptance04-May-2004


Background: Salmonella infection and diarrhoeal diseases are major causes of morbidity and mortality in the developing world. All expatriates applying for work permits in the Kingdom of Saudi Arabia (KSA) have to undergo a governmental compulsory health check program. Aim of the study: To estimate the number of salmonella carriers who had previously been diagnosed as free of infection. Subjects and methods: Over a period of two years, a total of 17, 918 workers in Al-Qatif area, in the Eastern Province were tested for salmonella on stool samples. Results: Three hundred and twenty eight were found to be asymptomatic carriers of salmonella. The highest frequency was found among workers from Egypt (13.1 %) while Filipinos and Indians were the lowest carriers (1.2%). Salmonella serogroups E, C 1 and C2 were most common ( 29%, 29% and 23.5% respectively) followed by serogroups B, D and C (13%, 3.7% and 1% respectively). No Shigella species were isolated. All carriers were given antibiotics and were instructed in prophylactic hygiene measures. After completing the course of antibiotics, they were retested and found to be clear of infection. Conclusion: The health check system in this area will contribute towards the prevention of outbreaks of infection by salmonella

Keywords: salmonella, carriers, expatriates, serogroups, health, asvmotomatic.

How to cite this article:
Albreiki HM, Al-Ali AK, Rayan AJ. Salmonella carriers among expatriate workers in Al-Qatif area. Saudi J Gastroenterol 2004;10:140-3

How to cite this URL:
Albreiki HM, Al-Ali AK, Rayan AJ. Salmonella carriers among expatriate workers in Al-Qatif area. Saudi J Gastroenterol [serial online] 2004 [cited 2022 Jan 17];10:140-3. Available from:

Samonella infection and diarrhoeal diseases are major causes of morbidity and mortality in the developing world [1] . Worldwide, it has been estimated that 4-5 million children and adults die annually of infectious diarrhea [2] . This threat continues to pose a major health problem in developing countries for immunologically naive children. The  Salmonella More Details bacilli are all pathogenic to a greater or lesser degree. A wide variety of salmonella serotypes are found in different geographical regions. In USA, S.typhimurium and S enteritidis are by far the most common, while in India, S typhi and S weltervreden are the most common [3] . The fecal-oral route is the main mode of transmission in this population [4] . A large number of expatriates from different parts of the world work and reside in the Kingdom. As part of health regulations in the Kingdom, all these expatriates are checked medically in order to obtain work permits or to renew their work licences. The overcrowded living conditions and inadequate hygiene facilities of the majority of these subjects results in poor sanitary conditions. These factors contribute toward outbreaks of salmonella infections. This retrospective study was carried out to estimate the number of salmonella carriers who had previously been diagnosed as free of infection in the KSA or in their own country. These subjects are the major cause of the limited spread of salmonella in various parts of the KSA [5] .

   Subjects and Methods Top

Over a period of two years (2000-2001), a total of 17,918 stool specimens from asymptomatic individuals were examined as part of a health check program for subjects applying for work and residency permits in Al-Qatif area in the Eastern Province of Saudi Arabia. Approximately 60% of the samples were from individuals working in the food industry and the remainder were laborers in other areas of the economy. The stools were collected in wide mouth water tight plastic containers with tight fitting lids. The speciemens were examined grossly for stool consistency and inoculated onto xylose lysine desoxycholate agar (XLD) after enrichment in 6m1 selenite F broth [6].

The isolated salmonella, were identified using API 20E strips (Analytab products, plain view, NY. USA) and serological methods. Serogrouping was performed using Kauffman and White procedure. Statistical analysis of the results was carried out by using SPSS program version 11.

   Results Top

A total of 17,918 stool speciments from subjects were examined over a period of two years of which 328 Were found to be asymptomatic carriers of salmonella. [Table - 1] indicates the distribution of the positive cases according to their nationalities. Egyptians had the highest incidence of salmonella infections (13.1%) than any other nationality. while Indians had the lowest incidence of infection (1.2%). This is in sharp contrast to previous reports, which have shown that salmonella is more common in Indians than in other populations [5] . This does not necessarily contradict other studies due to the fact that only a small number of subjects from Egypt were investigated. The highest frequency was found during the months of June to October. This is the time when most expatriates travel to their home country and subsequently return to the Kingdom.

[Table - 2] indicates that 82% of salmonella serogroups isolated belong to serogroups E, CI and C2 (29.8%, 29% and 23.5% respectively). All the carriers were given a course of Ampicili_n (50 mg, twice daily) or Trimethoprin (80mg, twice daily) for a period of 21 days. Surprisingly in all the positive cases of salmonella no antibiotic resistant species were isolated.

   Discussion Top

Salmonella organisms are commensals in the bowels of livestock and the oviducts of chickens [7] . Numerous serotypes o f salmonella (S. choleraesuis) car: cause gastroenteritis and the most common of these salmonella species are S. enteritidis and S. typhimurium [8] . They are usually transmitted to man by contaminated foodstuff. Enteritis caused by salmonella has been reported in many areas of the KSA [9],[10]. However, it has also been reported that ehteric fever due to salmonella infection is more common in non-Saudis than in the Saudi population [5],[11] . A large number of expatriates from different parts of the world, where salmonella infection is endemic work in the food industry in the KSA. Reports from these countries showed varying frequencies of bacterial agents of diarrhea [12],[13],[14],[15],[16],[17] . The majority of these workers travel to their respective countries at least once every two years, where they become exposed to infection. Many of these subjects are asymptomatic carriers and may contribute the transmission and local outbreaks of salmonella infection.

The isolation of salmonella from apparently healthy individuals working in the food industry may have an important public health implication [18],[19] . The Ministry of Health and the Ministry of interior have installed a health program through which all expatriates applying for work in the KSA should undergo a health check in their home country to ensure being free of infection. Based on this, the workers are given entry visas to the KSA. However, upon arrival these workers have to undergo a further medical check-up to confirm that they are free of any infectious diseases. Besides HIV, hepatitis, syphilis, diptheria and parasites, the stools of these subjects are checked for salmonella and shigella.

In the present study, 328 out of a total of 17918 expatriate subjects tested were confirmed to be asyptomatic carriers of salmonella. Salmonella groups E. C1 and C2 were the most common isolates found. These results agree with previously reported data on the predominant serogroups in the Kingdom [20] . The majority of the salmonella serogroups isolated were highly susceptible to commonly used antimicrobial agents. All positively identified - subjects were treated with a course of antibiotics and were issued health permits after they were found to be clear of infection. This is in order to protect the public where anyone who was found to be infected with salmonella and has a high risk job, such as food handlers, were not allowed to work until there was no longer a risk of infecting others. It can be safely assumed that these asymptomatic carriers may increase the incidence and the risk of local outbreaks of  Salmonellosis More Details among the population. Moreover, there is an increased risk of importing resistant species of salmonella to the Kingdom. Therefore, one has to emphasize the importance of the enforcement of health checks on all expatriate labourers prior to employment and after each travel outside the kingdom. These measures will certainly decrease the incidence of salmonella infection. In addition, it is believed that measures should be taken to raise public awareness of the hazards of salmonella infection by the distribution of a booklet to employees describing the seriousness of the situation.

   References Top

1.Edelman R, Levine M. Summary of an international workshop fever. Rev Infect Dis 1986; 8: 329-45.  Back to cited text no. 1    
2.Synder JD, Merson MH. The mabnitode of the problem of acute diarrhoeal disease: a review of active c'urveiliance data. Bull WHO 1980; 60: 605-13.  Back to cited text no. 2    
3.Bwa S, Dewan ML. Suri JC. Prevalence of salmonella serotypes in India, a 16-year study. Bill WHO 1976; 52: 331-6.  Back to cited text no. 3    
4.Gorbach SL. Bacterial diarrhea and its treatment. Lancet 1987; 2: 1378.82.  Back to cited text no. 4  [PUBMED]  
5.Malik GM, Al-Wabel AH, El Bagir Khalafalla Ahmed MM, Bilal NE, Shenoy A, Abdalla M, Mekki TE. Salmonella infections in Asir region southern Saudi Arabia: Expatiate implications. Ann Saudi Med 1993; 13: 242-5.  Back to cited text no. 5    
6.Lennette EH, Balows A, Hausler WJ Jr, Truant P. Manual of Clinical Microbiology. Washington: DC: American Society of Microbiology, 1980.  Back to cited text no. 6    
7.Koneman EW, Allen SD, William MJ, Schrectenberger PC, Wing Jr WC, editors. Color Atlas and Textbooks of Diagnostic Microbiology. Philadelphia-New York: Lippincott, 1997.  Back to cited text no. 7    
8.Moss PJ, McKendrick MW. Bacterial gasteroenteritis. Curr Opin Infect D/s 1997; 10: 402-7.  Back to cited text no. 8    
9.Gosling PJ, Kassim MA. Salmonella gastroenteritis in Jeddah: a study of 1017 patients over a fourteen-month period. Saudi Med J 1983; 4: 61-6.  Back to cited text no. 9    
10.Al-Bwardy MA, Ramia S, Al-Frayh AR et al. Bacterial parasitic and viral enteropathogens associated with diarrhoea in Saudi children. Ann Trop Paediatr 1988; 8: 26-30.  Back to cited text no. 10    
11.Al-Freihi H, Twum-Danso K, Sohaibani M, Bella H, El-Mouzan M; Sama K. The microbiology of acute diarrhoeal disease in the Eastern Province of Saudi Arabia. East Afr Med J 1993; 70: 267-9.  Back to cited text no. 11    
12.Adkins HJ, Escamilla J, Sandiago LT, Ranoa C, Eskheverria P, Cross GH. Two Year survey of etiologic agents of diarrheal disease at San Lazaro Hospital, Manila, Republic of the Philippines. J Clin Microbiol 1987; 25: 1143-7.  Back to cited text no. 12    
13.Albert MJ, Faruque ASG, Sack RB, Mahalanabis D. Case control study of enteropathogens associated with childhood chiarrhea in Dkaka, Bangladesh. J Clin Microbiol 1999; 37: 3458-64.  Back to cited text no. 13    
14.Stoll BJ, Glass RI, Huq Mi, Khan MU, Holt JE, Banu H. Surveillance of patients attending a diarrheal disease hospital in Bangladesh. Br. Med J 1982; 285: 1185-8.  Back to cited text no. 14    
15.Oyota BA, Lesmana M, Subekti D. et al. Surveillance of bacterial pathogens of diarrhea disease in Indonesia. Diag Microbior infect Dis 2002; 44: 227-34.  Back to cited text no. 15    
16.John TJ. Emerging and re-emerging pathogens in India. Ind J Med Res 1996; 103: 4-18.  Back to cited text no. 16    
17.Wasfy MO, Frenck R, Ismail TF, et al. Trends of multiple-drug resistance among salmonella sero type Typhi isolates during a 14-year period in Egypt. Clin Infect Dis 2002; 35: 1265-8.  Back to cited text no. 17  [PUBMED]  [FULLTEXT]
18.Al-Ahmadi KS, El Bushra HE, Al Zahrani AS. An outbreak of food poisoning associated with restaurant-made mayonnaise in Abha, Saudi Arabia. J Diarrhoeal Dis Re., 1998; 16: 201-4.  Back to cited text no. 18    
19.Al Ghamdi M, Al-Sabty S, Kannan A, Rowe B. An outbreak of food poisoning in the workers' camp in Saudi Arabia caused by salmonella minnesota. Diarrhoeal Dis Res 1989; 7: 18-20.  Back to cited text no. 19    
20.Al-Zamil F, Al-Anazi AR. Serogroups and antimicrobial susceptibility of non-typhoidal salmonellas in children. Saudi Med J 2001; 22: 129-32.  Back to cited text no. 20    

Correspondence Address:
Amein Kadhem Al-Ali
College of Medicine, King Faisal University, P O Box 2114, Dammam 31451
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

PMID: 19861837

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